Question 1

What is Ultherapy?

Accepted Answer

Ultherapy is a nonsurgical skin tightening procedure. Using high-focused, intense ultrasound energy, it gently heats the tissue below the surface of your skin, stimulating the body’s natural collagen growth. Most patients need just a single treatment session to achieve natural-looking results that improve over time.

It’s the only device of its kind that is FDA-cleared to lift tissue on the brow, neck (including the jawline), and under the chin, and to improve lines and wrinkles on the décolletage.

Providers also commonly use it off-label on other parts of the body with loose skin, such as on the abdomen and above the elbows or knees.

Question 2

What are the pros and cons of Ultherapy?

Accepted Answer

Pros

Ultherapy firms and lifts loose skin by jumpstarting the production of new collagen. In a 2019 study, 85% of patients treated for sagging of the midface and lower face were satisfied with their results.
It can also be an effective treatment for “turkey neck.”
You may also notice a decrease in fine lines and wrinkles in the treated area.
The noninvasive procedure bypasses the surface of the skin, so it comes with minimal side effects and downtime.
The procedure provides some immediate improvement, as the heat contracts existing collagen fibers, with increasing benefits over the next three to six months as new collagen develops.
It’s suitable for all skin types and tones, so most people with mild to moderate skin laxity can be good candidates. Dr. Dilip Madnani, a facial plastic surgeon in New York City, says that “there really aren’t any medical contraindications for this procedure.”

Cons

People with severe skin laxity and sagging aren’t good candidates for Ultherapy.
Despite often being advertised as a nonsurgical facelift, results are far less dramatic than what you’d get with a surgical facelift, and they don’t last nearly as long.
Treatment sessions can be painful, though your provider should give you medication to make it more comfortable. “We also use Pro-Nox nitrous oxide during treatments [self-administered laughing gas], to maximize comfort,” says Dr. Madnani.
You’ll have to wait a few months to see significant results from your treatment. “It takes time before collagen contracts and remodels,” explains Dr. David Lim, a dermatologist in Queensland, Australia. In fact, “it may take up to 4 to 6 months to see the best results.”

Question 3

How much does Ultherapy cost?

Accepted Answer

The price you pay will depend on the experience level of your provider, their office location, and a few other key factors.

You can finance your treatment with CareCredit.

See our complete guide to Ultherapy costs

Question 4

Ultherapy before and after pictures

Accepted Answer

The Ultherapy photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Question 5

Does Ultherapy really work?

Accepted Answer

The consensus among doctors on RealSelf is that Ultherapy treatment definitely works, but results can be subtle and don't always align with patient expectations, which is reflected in its Worth It Rating. The fact that some providers market Ultherapy as a nonsurgical facelift fuels confusion over what it can really deliver.

“I tell my patients that it’s about 10-20% of a facelift result,” says Dr. Madnani. He has an Ultherapy treatment himself “every few years, to keep my skin tight,” and he often suggests it for his younger patients.

Even though it’s not a replacement for facelift surgery, he says “it can delay the process. It’s also great for patients who have already had cosmetic surgery and are looking for maintenance,” as well as those who want to avoid a surgical facelift and have realistic expectations.

New York City dermatologic surgeon Dr. Ronald Shelton agrees. “The treatment is very effective. It doesn’t duplicate the results of a facelift, but it can postpone the need for surgery for many years.”

“The absolute most common issue with Ultherapy is matching results with expectations,” says Dr. Stephen Prendiville, a facial plastic surgeon in Fort Myers, Florida. “Many patients expect a facelift result from Ultherapy, which will never be possible.”

Related: The Top Skin Tightening Treatments, According to the Experts

Question 6

Who is a good candidate for Ultherapy?

Accepted Answer

People with mild to moderate skin laxity find Ultherapy most beneficial. A good candidate is usually in their 30s, 40s, or early 50s, with skin that’s started to look less firm, leading to a lowered eyebrow line, sagging neck skin, or early signs of jowls along the jawline. The treatment is suitable for any skin type or tone.

“The key characteristic for improvement with Ultherapy is not the patient’s age, but their skin elasticity and lack of deep sun damage,” explains Dr. Shelton.

“Many patients refuse to consider facelift surgery or are not surgical facelift candidates yet. This is the sweet spot for Ultherapy,” says Dr. Madnani. “There are also many patients who are not medical candidates for surgery due to underlying health conditions, and they can be given this option for noninvasive skin tightening.”

Even if you’re a good candidate, Ultherapy alone might not create the results you’re after. “In my practice, we love combining treatments to get the best results,” says Dr. Madnani. “Combining Ultherapy with laser treatments, injectables, or other skin lifting procedures is usually the best way to go.”

Related: 5 Signs You’re a Good Candidate for a Facelift—and 5 Signs You’re Not

Question 7

What happens during an Ultherapy treatment?

Accepted Answer

How long your procedure takes will depend on your individual treatment plan: a face-and-neck procedure takes between 60 and 90 minutes, while a chest treatment takes about 30 minutes.

Here’s what to expect:

First, your skin will be numbed with a topical numbing agent. You'll probably also be given oral pain medication (which takes about an hour to kick in) and Pro-Nox nitrous oxide (also called laughing gas), to minimize discomfort.
Your provider will apply an ultrasound conductive gel to the skin.
Then they’ll move a handheld device across the skin’s surface, to transmit the ultrasound energy to the deeper skin layers.
The device uses focused ultrasound imaging, so the energy targets the right depth at the optimal temperature to jumpstart collagen production. “Thanks to the ultrasound monitor, your doctor can see where they’re treating, visualize the connective tissue, and know at what tissue depth they need to treat in order to be effective,” Dr. Shelton says.
Your doctor will adjust the treatment depth for each area, using different ultrasound transducers that attach to the handpiece in order to deliver the energy to specific layers of tissue—the superficial dermis at 1.5 mm, the deep dermis at 3 mm, and the SMAS/platysma muscles at 4.5 mm.
“We draw outlines of the treatment areas and then determine the amount of energy, or lines, to be delivered at specific depths in each area,” explains Dr. Madnani. “The depth varies between patients, depending on their skin quality and thickness, which the ultrasound allows us to view in detail. With experience, there are many treatment ‘tricks’ we use to further improve results, so it’s very important to go to a provider who has lots of experience with this procedure.”

RealSelf Tip: Why is collagen so important? It’s the natural protein that provides structure to the skin—making up 75–80% of it. Your body’s collagen production slows with age. When collagen thins out, the skin is left with a weaker inner structure and becomes prone to sagging and wrinkles. Treatments like this one trick your body into increasing collagen production, to regain lost thickness and firmness.

Related: What It's Really Like to Get Ultherapy—and Why I Think It's Worth It

Question 8

Does Ultherapy hurt?

Accepted Answer

Having Ultherapy treatment without topical numbing and pain medication is not recommended, and most providers also offer options to ease patient anxiety.

“My patients typically get some pain medication, so we like them to come in an hour before the actual treatment,” Dr. Shelton says. Depending on a person’s pain threshold, that could be Percocet, Ativan for relaxation, a little nitrous oxide (laughing gas), or even numbing cream. “All that certainly makes it more manageable for patients,” he says.

While the procedure is ultrasound-based, it’s very different from diagnostic ultrasound imaging: this cosmetic treatment uses heat energy, with temperatures reaching as high as 140°F in the deep subcutaneous tissue.

Even with pain medication, it's no walk in the park. Thankfully, the discomfort lasts only as long as the ultrasound energy is being delivered (usually only a second and a half or less per pulse), and any discomfort stops once the treatment is completed.

There have been clinical studies to measure patient comfort during treatment sessions, so doctors are well aware that pain management and setting the expectation of some level of discomfort is important for building trust and improving their patients' experience.

“What I tell my patients is, ‘It hurts, but it works,’” says Dallas-based dermatologist Dr. Mary Hurley. “My patients have seen tremendous results in the face, neck, and chest from Ultherapy.”

Related:5 Ways Doctors Lessen the Pain of Injectables, Lasers & Devices

Question 9

Is there downtime after Ultherapy?

Accepted Answer

Most patients have no or very minimal downtime afterward. You may experience some slight redness, swelling, and (very rarely) bruising and welting during your Ultherapy recovery. It's a good idea to book your treatment at the end of the week, so you'll have the weekend for any visible signs to clear up before you head back to work.

You may also feel a bit sore or tingly in the treated areas for anywhere from a few hours to a few weeks afterward.

“After the treatment, it is common to experience some tenderness under the chin, near the cheekbones, and along the jawline, which is often described as a soreness that is really only noticed when touched,” says Dr. Pamela Henderson, a plastic surgeon in Scottsdale, Arizona. “It’s also common to experience some degree of numbness in those same areas. Both of these symptoms generally resolve in days or [within] a couple of weeks, depending on the intensity of the treatment.”

According to Dr. Shelton, residual soreness is actually a good sign. “It means you are producing more collagen.” And while the soreness may persist for a few weeks, it won’t interfere with your quality of life. “It’s not anything that has bothered my patients,” he says. “They haven’t had to curtail their activities.”

Thankfully, there are ways to reduce the chance of bruising:

Patients are advised to stop taking blood thinners, if their physicians allow them, 10 days before the procedure. You should also stop taking aspirin, nonsteroidal anti-inflammatory agents, fish oil supplements, vitamin E pills, and other similar medications (though this isn’t mandatory).
Avoiding alcohol for several days before and after your treatment can also help.

Depending on the strength of pain medication you’ve taken, you may need to have someone you trust take you home after your treatment. But you should be able to go back to work and resume your normal activities as soon as the effects have passed.

Question 10

How long does it take Ultherapy to work?

Accepted Answer

Some people see subtle firming right after their treatment, from the contraction of existing collagen fibers. But according to Dr. Shelton, “the real magic happens over the next 3 to 6 and even up to 12 or more months as your body steps up collagen production.” This biological response takes time.

When choosing someone to perform an Ultherapy procedure, be aware that “the more experience a technician has, the better the results,” according to Seattle dermatologist Dr. Jennifer Reichel. “Also, you have to be the right candidate. Noninvasive lifting devices will not replace a surgical facelift, if that’s really what you need.”

It’s key to have a consultation with a doctor who is board-certified in dermatology or plastic surgery in advance of setting up your procedure. This way, you can establish that Ultherapy is the right treatment for your goals.

Related: 5 Popular Nonsurgical Procedures You Need to Do Only Once to See Results

Question 11

How long does Ultherapy last?

Accepted Answer

Results aren’t permanent: they usually last between one and two years. A combination of a medical-grade skin care regimen (including daily sun protection) and a healthy lifestyle can help extend your results.

“People often ask me, ‘Well, how long does it last?’” Dr. Shelton says. “The new collagen lasts for years, but we’re fighting the ongoing aging process and gravity.” Because of this, you’ll likely need to return for more sessions as the natural aging process continues.

“It’s not unusual for people to return every two years for an additional Ultherapy treatment, to maintain their results,” according to Dr. Shelton. “More and more, we are seeing patients who would like to be proactive and ‘prejuvenate,’ rather than rejuvenate their skin, to forestall aging effects. They start treatment very early, when the skin has a hint of sagging, then repeat it as frequently as every six months.”

Question 12

Is Ultherapy safe?

Accepted Answer

Ultherapy is considered to be safe, but there are still risks and potential side effects, particularly in inexperienced hands. For example:

Too much heat applied too close to the skin’s surface can cause welts.
Patients can experience numbness, burning, and even nerve weakness, in rare cases.
A 2017 study published in Lasers in Surgery and Medicine noted five patients who had developed blisters, erosion, or ulceration of the skin, as well as inflammation and swelling, followed by tissue atrophy or necrosis after a single treatment session with the ultrasound technology. They concluded that “despite their rarity, serious adverse events secondary to microfocused ultrasound are nevertheless possible and may be underreported.”
Some RealSelf members say that they have experienced fat loss following Ultherapy treatment, though a 2019 study published in Plastic and Reconstructive Surgery—Global, did not report fat loss, and many providers on RealSelf say they haven’t seen this complication in their practices.

“I have been doing Ultherapy for several years with good patient satisfaction and am not aware of one case of fat loss,” says NYC dermatologic surgeon Dr. Ron Shelton.

Still, some providers do report having seen fat loss. “I’m not sure how many people suffer fat loss from Ultherapy. But I regularly see people in my office for fat grafting after Ultherapy, radiofrequency, or IPL (Photofacial) have left them with fat loss and unevenness,” says Dr. Michael Law, a plastic surgeon in Raleigh, North Carolina.

If fat loss does occur, the amount shouldn’t be significant, says Dr. Rekha Tailor, a physician in Elstead, England. “The effect of Ultherapy on facial fat loss has been studied in detail by the FDA, and it is not significant. They have not issued any warnings or cautions. If a full-face treatment was done and all the energy was delivered to the layer which contained some fat—which is not the case with the protocols that we use—then the amount of fat loss is 1.25ml, which is less than a quarter of a teaspoon. As we age, we lose facial fat, and the Ultherapy treatment tightens and lifts. Hence, you will be tighter and firmer after Ultherapy, but may look a little hollow due to the natural aging process.”

To mitigate these risks, seek an experienced provider with a proven track record of positive reviews and before and after photos from real patients. Most adverse effects can be avoided with careful monitoring throughout the procedure, to ensure that appropriate levels of heat are delivered at the right depths.

Question 13

Thermage vs. Ultherapy: What's the difference?

Accepted Answer

Thermage is another nonsurgical, noninvasive treatment option used to tighten loose skin. It uses radiofrequency energy instead of ultrasound energy to stimulate collagen production. Most patients find it isn’t as effective as Ultherapy and takes longer to deliver results.

“When more tightening is needed, I turn to Ultherapy,” says Dr. Heidi Waldorf, a New York City dermatologist. “If a patient has thinner or more sun-damaged skin or the problem area is mostly lax skin under and on the neck, Ultherapy allows me to target multiple levels of deeper tissues.”

Dr. Madnani underscores that the biggest factors in your results are your provider’s level of experience and whether you’re truly a good candidate for nonsurgical skin tightening.

“There are many energy-based devices out there—ultrasound-based, radiofrequency-based, and laser-based. They all deliver heat to deeper layers of skin, to promote collagen production. How that’s done is decided by your provider, and results are based on patient selection and provider experience.”

Related: The Treatments and Products 4 Dermatologists Use to Anti-Age Their Own Necks

Question 14

Sources & studies

Accepted Answer

Fabi, Sabrina G, et al. “Practical Guidance for Optimizing Patient Comfort During Microfocused Ultrasound with Visualization and Improving Patient Satisfaction.” Aesthetic Surgery Journal, 14 Mar. 2019.

Fabi, Sabrina G., et al. “Combining Microfocused Ultrasound With Botulinum Toxin and Temporary and Semi-Permanent Dermal Fillers.” Dermatologic Surgery, vol. 42, May 2016.

Friedmann, Daniel P., et al. “Complications from Microfocused Transcutaneous Ultrasound: Case Series and Review of the Literature.” Lasers in Surgery and Medicine, vol. 50, no. 1, 20 Nov. 2017.

Office of Device Evaluation Center for Devices and Radiological Health. “510(k) Summary for the Ulthera System.” United States Food and Drug Administration, 20 June 2014.

Shome, Debraj, et al. “Use of Micro-focused Ultrasound for Skin Tightening of Mid and Lower Face.” Plast Reconstr Surg Glob Open. 2019 Dec.

ULTHERAPY

Dilip D. Madnani, MD, FACS

Megan Deem

Dilip D. Madnani, MD, FACS

Megan Deem

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Dilip D. Madnani, MD, FACS

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ULTHERAPY QUESTIONS

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